摘要
目的：探讨腹腔镜根治性膀胱切除术治疗肌层浸润性膀胱癌的初步经验，评价此术式的可行性及临床疗效。方法：回顾分析2l例肌层浸润性膀胱癌患者行腹腔镜根治性膀胱切除术的临床资料，患者均行腹腔镜下标准盆腔淋巴结清扫、根治性膀胱切除术及尿流改道术，包括11例Bricker回肠膀胱术，4例输尿管皮肤造1：2术，6例Studer原位新膀胱术。观察手术时间、术中出血量、术后肠道功能恢复时间、术后并发症及手术疗效。结果：21例手术均获成功。手术时间平均（390±46．2）min，术中出血量平均（270±101．1）ml，1例输浓缩红细胞2个单位。术后3～5d恢复肠蠕动。术后并发症发生率19．O％（4／21）。平均随访（12±5．5）个月，总生存率85．7％（18／21），1例死于肿瘤远处转移，2例死于心脑血管疾病。结论：腹腔镜根治性膀胱切除术具有患者创伤小、出血少、术后康复快等优点，是治疗肌层浸润性膀胱癌安全、有效、可行的方法。具备开放根治性切除术的手术经验及腹腔镜技术熟练的医院可尝试开展。初期开展，Bricker回肠膀胱术可作为首选的尿流改道术式。
Objective：To investigate the initial experience,evaluate the feasibility and clinical efficacy of laparoscopic radical cystectomy for muscle invasive bladder cancer. Methods：Clinical data of 21 patients with muscle invasive bladder cancer who received laparoscopic radical cystectomy were retrospectively analyzed. All patients underwent laparoscopic standard lymphadenectomy at pelvic cavity, radical cystectomy and urinary diversion surgery including Bricker ileal conduit （ n = 11 ）, cutaneous ureterostomy （ n = 4 ） and Studer orthotopic neobladder （ n = 6）. The operation time, the intraoperative blood loss, the postoperative intestinal function recovery time, the complication and the operative efficacy were recorded. Results：All the operations were successfully performed. The mean oper- ative time was （390 ~ 46.2） min, the mean intraoperative blood loss was （270 ~ 101.1 ） ml, one case received blood transfusion （2 U concentrated red blood cell）. Postoperative intestinal function recovery time was 3-5 d. The total postoperative complication rate was 19.0% （4/21）. The overall survival rate was 85.7 % （ 18/21 ） with the mean follow-up of （ 12 ~ 5.5 ） months, but 1 case died of dis- tant metastasis of urothelial carcinoma and 2 cases died of cardiovascular and cerebrovascular diseases. Conclusions： Laparoscopic radi- cal cystectomy is a safe ,feasible and efficient method for the treatment of muscle invasive bladder cancer with advantages of minimal in- vasion, few blood loss and quick recovery. It is expected to be carried out in the hospital with rich experience of the open radical cystec- tomy and skilled laparoscopic operation technique. At the beginning, Bricker ileal conduit is the first choice of urinary diversion operation.
出处
《腹腔镜外科杂志》
2014年第2期99-101,共3页
Journal of Laparoscopic Surgery
